Pharmacist in practice: ‘I get to learn something new every day’

As part of our pharmacist in practice series, The Pharmacist speaks to Shivani Patel, lead clinical pharmacist for a GP federation in north central London.

How long have you been working in general practice and what were you doing before?

I went into general practice around 2017 and that's where I've been ever since. I was in community pharmacy just before that.

What attracted you to working in general practice?

I think at the time, I felt there was a lack of clear progression in community pharmacy itself. Quite quickly, I was offered a store manager position within a few months of qualifying, and I just thought I would probably peak quite quickly in my career, and maybe it was time to consider something very new and different. And back then general practice was very new for pharmacy – so I thought I'd give it a go.

I'm really glad I made the switch. At the time, it felt really risky, because in my universe we didn't know what it was all about. We'd always been told we'd either end up working in a hospital or on the high street. I went in blind, but I don't regret it at all because I think this is the best place for me. I get to build rapport with my patients; I get to use my clinical expertise and develop and learn something new pretty much every day. So, it worked out well.

Are you currently undertaking any training?

I've completed my CPPE and IP training, which was OK. I think the timing of these are very important and it would work better for people who are quite early in their primary care career, whereas I didn't do CPPE until two and a half years after I'd already been in general practice. I think experiential learning is probably best in this type of setting, where the sky's almost the limit with your scope of practice.

Do you have any areas of special interest or any particular projects that you’re working on?

My special interests are diabetes, CKD and heart failure. My role has become a leadership role as well, so I'm not just in clinic. The projects that I'm working on are more leadership focused rather than clinical. It's more about looking at how we support others and developing our workforce in primary care.

At the moment, I'm working quite closely with Health Education England, as well as our training hub, to be able to improve the experience of those doing IP training. The aim is to make sure people who do IP training are actually able to utilise it better once they get their certificates.

What does your job look like day-to-day?

When I'm in clinic, I generally have my telephone or face-to-face appointments in the morning. That would be for virtually any long-term condition – reviews, but also looking at polypharmacy reviews, reviewing results coming in, or any related queries. Then later in the day, I would be helping with triaging lab results and looking at prescriptions, as well as actioning clinical correspondence. I also have a supervisory function where I support trainee pharmacists, for example, as well as a trainee technician. We also get lots of queries from the clinical team. So that's basically how my day is split.

What is the biggest patient need in your area and how does that influence your work?

One of the challenges at the moment is multimorbidity, and another is mental health. There's also a challenge in balancing expectations versus the reality of, for example, appointment times or delays in services because there's a backlog. That's something that's been quite prominent in the last couple of months.

In general practice, you're the go-between, and you have to come up with a solution, because, ultimately, the patient is your responsibility. A good example of that would be ADHD clinics and the waiting times for those. Some patients will go abroad or go private and then expect things to be prescribed on the NHS. So, from our standpoint, it's really difficult because we can happily make a referral, which might take two years - but in the meantime, what do we do to support them?

How do you work in a team with your practice colleagues?

We get together every week for about 45 minutes to discuss complex cases. We share things like project results, audit results or any significant events. We also discuss, for example, any safeguarding concerns that have come up or any significant events or complaints.

I think this way of working is really important, because it helps showcase the role of pharmacists. Also, it's completely multidisciplinary so it reinforces what we bring to the table and where we stand in the team. In fact, I think it's quite difficult for my practice to envision a meeting without a pharmacist's input, because there will be something to do with medicines or long-term conditions for nine out of 10 patients.

Another example of working in a team is supporting other colleagues – more junior colleagues, or even HCAs or nursing staff who are doing the bulk of the face-to-face physical reviews for long-term conditions. For example, if there's raised blood pressure, that's more likely to come to a pharmacist to action appropriately, rather than to the doctor.

How do you work with community pharmacists?

I think it could definitely be more proactive than it probably is across the board. At the moment, it's often limited to day-to-day queries, or any kind of medicine-related queries, patients who are on dosette boxes and require some adjustment, for example.

But actually, in other parts of the borough, some of the pharmacists worked really closely with community pharmacists to get the ambulatory blood pressure monitoring system going, and that was really successful. Those results would come into the practice pharmacists. So, it was very pharmacy-focused and the outcomes for the patients were brilliant in terms of access, and actions off the back of those results.

What do you think will be the biggest opportunities and challenges in the sector as a whole, over the next five years?

I think there's definitely a challenge regarding the uncertainty around the new contract and how funding can be used.

In terms of opportunity, I'm very lucky that there is an appreciation for pharmacy leadership and what that looks like, and the outputs from the pharmacists have been very successful, so that leadership model speaks for itself.

We know the workforce challenges with doctors and nurses in primary care, and I think there's an opportunity to actively learn and reflect on what's gone wrong with those workforce models, and how we can actively prevent that with this very successful emerging workforce so that in 10 years' time or five years' time, we're not having the same conversations about burnout or lack of supervision, or concern about retention with pharmacists.

So instead of worrying about it when it happens, we should think proactively about what we can do to nurture this workforce.

What other changes would you like to see?

I'd like to see more appreciation of pharmacy leadership and funding tied to primary care, specifically.

Also, I'd like to see more ways of working with the old medicines management teams, which are now essentially renamed as ICBs. I'm not convinced there is much primary care representation at ICB level, so I think primary care from a commissioner standpoint has changed from what it used to be, but what's actually happening on the ground is not reflective of that.

And what do you like to do in your time off?

I like to socialise and travel. I guess my work-life balance is good. I think what's important to me is that I enjoy what I'm doing, and I can see how that's important to patients or other people in my team.